Retropupillary iris-claw intraocular lens for the surgical correction of aphakia in cases with microspherophakia

Abstract

Purpose:This study aimed to evaluate the safety and efficacy of retropupillary fixation of an iris-claw intraocular lens (IOL; Verisyse polymethyl methacrylate IOL, Abbott Medical Optics [AMO], Netherlands) for the surgical correction of aphakia in microspherophakic eyes without sufficient capsular support.Design:This was a prospective, interventional, noncomparative case series.Methods:This interventional case series comprised 17 eyes of 9 microspherophakic patients. Retropupillary fixation of the Verisyse iris-claw IOL (AMO) was performed in all cases. The surgical time was measured. Corrected distance visual acuity, astigmatism, intraocular pressure (IOP), tissue reaction, pigment dispersion, and stability of the IOL were studied 1 day, 3 days, 1 week, 2 weeks, 1 month, and 6 months postoperatively.Results:Eight patients had familial microspherophakia and one patient had Marfan's syndrome. Eighty-two percent of the cases achieved a visual acuity of 0.3 or better. There was no significant postoperative inflammatory reaction. Transient elevation of IOP was recorded in two cases in the 1st week only. One IOL developed disengagement of one of the haptics from the iris and was successfully re-engaged. All the other IOLs were well centered and stable. The mean surgical time was 18.0 ± 4.5 min.Conclusions:Retropupillary fixation of an iris-claw IOL is a safe and effective procedure that provides early visual recovery. It is also a time-saving method for correcting aphakia in microspherophakic eyes without sufficient capsular support.

Comparative analysis of retropupillary iris claw versus scleral-fixated intraocular lens in the management of post-cataract aphakia

“…[2] Recently, interest has been revived in retropupillary fixation of the iris claw lenses in view of their ease of surgery and relatively good results. [89101112131415161718192021222324] The retropupillary fixation of the iris claw lens theoretically reduces the risk of corneal endothelial damage but may be associated with higher incidence of pupillary distortions, glaucoma, and other complications. However, many studies have shown excellent outcomes and have established the effectiveness of this surgical approach in correcting aphakia.…”

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

“…Nevertheless, a convex–concave design has a better safety profile, and a peripheral iridectomy is not required with this design. 17 , 24 , 26 , 28 , 36 , 54 …”

“…Peribulbar, subtenon, or retrobulbar anaesthesia is preferred while implanting ICIOL, as the surgical manoeuvres, including iris-touch and enclavation, may induce pain. 16 , 17 , 21 , 24 , 26 , 36 The pupil should neither be dilated nor constricted. Mohr et al suggested a pupil size of 4–5 mm, optimal for secondary ICIOL implantation.…”

“… 61 However, in cases of primary implantation of ICIOL or exchange of IOL, which require dilated pupil, a constrictive agent like carbachol or pilocarpine must be injected intracamerally before enclavating the haptics of ICIOL. 17 , 21 , 24 , 26 , 28 , 36 The size of the pupil should be assessed before injecting the constricting drug, and one should proceed cautiously to avoid sphincter trauma while enclavating the haptics.…”

“…Different authors have reported using a corneal incision or a scleral tunnel incision at the 12 o’clock position for implanting ICIOL. 16 , 17 , 21 , 24 , 26 , 36 However, the size of the ICIOL demands a 5.4 mm incision, which can be considered as one of the drawbacks of ICIOL. Hence, making a sclero-corneal tunnel is preferable as it reduces the surgically induced astigmatism (SIA) and chances of wound leakage and endophthalmitis.…”